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Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE SEPTEMBER 2000 ISSUE THE POISON SLEUTHS DEATH BY BOTULINUM TOXIN -Dr. Anil Aggrawal “Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a young man today. What happened to him? Please tell me.” “Good morning Tarun. The name of this young man is Badal and he died in the hospital today morning, i.e. on 16th September at about 9 am. The doctors could not find out the cause of his death. He is only 25 years old, and everybody is concerned why he died. That is why the police has brought his body to me. My job of course is to find out how he died.” “Please explain the circumstances of his death doctor.” “Badal and Shatru were friends and they both loved a 21 year old girl Sudha. Both wanted to marry her, but Shatru could go to any length to get her. It so happened that Sudha showed more interest in Badal. Many times Shatru had asked Badal to get out of his way, otherwise the consequences would not be good for him. But Badal ignored his threats taking them to be just friendly pranks. On the outside both of them remained as friends, although it appeared to many that Shatru held a grudge against Badal. Badal was working as a clerk in a local private company and was living alone on a rented flat. On 12th September Shatru came to his flat in the evening with a bottle of whiskey apparently to celebrate his birthday. They both had whiskey together, and had dinner together. On 13th Badal was fine. On 14th morning, Badal started having some strange symptoms. First he had nausea, vomiting, diarrhea, abdominal distension and abdominal pain. He thought he was having an ordinary bout of diarrhea and contacted a local doctor for this. He too thought that he was having an attack of gastroenteritis, and prescribed some standard medicines. But they could not prove beneficial. On 15th morning, Badal developed double vision, technically known as diplopia, difficulty in speaking (dysarthria and dysphonia) and difficulty in swallowing (dysphagia). He became alarmed, informed one of his neighbors who immediately took him to a nearby hospital, where the doctors started investigating his illness. At the hospital, he reported some additional symptoms. He had dizziness, very dry and sore throat, blurred vision and drooping of eyelids. But the most alarming symptom of all was a paralysis of the muscles of his face and neck, which gradually moved downwards. That means that after the development of paralysis of muscles of his face and neck, first his arm muscles became paralysed, and then his leg muscles. Quite remarkably there was no fever. I have talked to the doctors who were treating him, and I have been told that his pupils were dilated. The doctors tried their level best to save him, but he died today morning, i.e. after about 48 hours of having those strange symptoms. On hearing his death, Badal’s family members have arrived here from the capital. They are blaming Shatru for his death. They think that when Shatru came to Badal’s house on 12th, he probably gave him some poison mixed in whiskey. They say that Shatru could do anything to get him out of his way. They are obviously very well connected. There was tremendous pressure on police to catch Shatru, and they have caught him today. But Shatru says he is innocent, and that he has done nothing.” “Doesn’t look like Shatru killed him. After all, Badal started having those symptoms almost 36 hours after he had that meal with Shatru. I have been discussing poisons with you for quite some time now. I don’t know of any poison which starts its action so late after being administered. To me it looks like he had a terrible disease. What disease did he die of doctor? Tell me.” “Tarun, I can say anything definitely only after a thorough post-mortem examination, but from the symptoms which have been told to me by the police and by the treating doctors at the hospital, I am of the opinion that Badal died of Botulism.” “Botulism? As far as I know this is a disease connected with food poisoning. Then why have the police apprehended Shatru? They must immediately release him.” “Tarun, I have asked them to continue keeping him in custody. I learnt that Shatru had studied microbiology at M.Sc. level. So I don’t want to take chances. I want to exclude everything, before I can say anything with confidence. In one of my earlier discussions with you (See Science Reporter May 1998 issue), I told you that the symptoms of botulism may resemble that of barium poisoning . In fact, so similar may be the symptoms that according to most doctors, barium poisoning should always be considered as a possible diagnosis in all cases of food poisoning accompanied by neurological complications. So the first thing I did was to exclude barium poisoning in this case, by checking for barium levels in various organs of Badal. And I could safely exclude barium poisoning, as I did not find any barium there.” “But if it is not barium, how can it be botulism? I mean how could Shatru give him Botulism even if he wanted to?” “Tarun, do you know that Botulin toxin is now used as a medicine too? And that medicine is available in vials. A certain number of vials, if mixed in one’s food, can definitely kill a person.” “A toxin being used as a medicine? Never heard of that. Looks like we are on to one more of your fantastic poison stories. Well, why don’t we begin from the beginning?” “Tarun, Botulism is a disease caused by the gram positive bacterium Clostridium botulinum. Before proceeding further I may tell you that the term gram positive refers to certain bacteria which take up a violet stain when stained with a special staining technique called gram staining. Gram staining was developed in 1884 by a Danish physician Hans Christian Joachim Gram (1853-1938). Bacteria which take up a pink color by this staining method are referred to as gram negative bacteria. So much so about gram staining and its nomenclature. So I was telling you about the Clostridium botulinum bacterium. I may tell you that its name comes from Latin botulus, meaning sausage. Indeed consumption of contaminated sausage was one of the major causes of this condition, when it was first recognized. It can however be caused by contamination of any type of foodstuff - vegetarian and non vegetarian. This bacterium is present in soil and infected water. Improper canning of foods at home may cause some contamination of food with soil or infected water during the process of canning. When canning is complete, the contents inside are devoid of air, a condition which is very much loved by these bacteria. In fact in technical terms Clostridium botulinum is known as a strict anaerobe, which means that a lack of oxygen is necessary for its growth; it gets killed in the presence of oxygen. This might appear paradoxical to you, since we are so used to talking about organisms which need oxygen for growth, but this is a fact. In an environment, which lacks oxygen, i.e. the closed can, these organism keep on multiplying. They produce a toxin known as botulin, which is supposed to be the most toxic substance found in nature. When someone consumes this food, he unwittingly consumes the toxin, and immediately becomes sick. He is said to be suffering from botulism. And he depicts almost the same symptoms, which were shown by Badal before his death. To summarize, we can say that Botulism is caused when food contaminated with Clostridium botulinum is canned or otherwise stored for long periods in anaerobic conditions.” “Doctor, many bacteria have different strains. Are there different strains of these bacteria too?” “Yes, there are eight different types of botulinum toxins have been described, and all of them are released by different strains of bacteria. They are all Clostridium botulinum, but differ in very subtle ways, so they are known as different strains of Clostridium botulinum. These different toxins are designated as A, B, C1, C2, D, E, F, and G. All are neurotoxins (poisons affecting the nerves), except for C2, which is a cytotoxin (poison having a direct effect on cells). Its significance is not clear. All these toxins are proteinaceous in nature, and thus antibodies against them may be prepared. However antibodies against any one of these toxins is effective only against that particular toxin and not against any other. Human poisoning mostly occurs due to A, B, and E. Type E poisoning is frequently associated with fish products. Rarely F and G can also cause human poisoning. C1, C2, and D cause poisoning in some mammals and birds. The toxin is not destroyed by acid or proteolytic (protein splitting) enzymes, but is heat labile and is destroyed when heated to 800C for 30 minutes, or 1000C for 10 minutes as during routine home cooking. It is thus a good practice to heat the canned food properly before cooking. Botulinum Toxin A (also known as BTX-A) has been isolated as a pure crystalline protein and is the most potent toxin known to man. You may be surprised at the fatal dose of this toxin. It is just 1 pg (10-12 g)/kg of body weight. This means that just about 10-10 g of toxin is required to kill a 100 Kg man! Even lesser doses would be required for ordinary human beings weighing 60-70 kg. Another figure may give you some idea of its lethality. One g of BTX-A toxin would kill 30,000 million mice! About 3 million molecules injected in the abdomen of a mouse would kill it. That would sound like lot of molecules, but the very fact that its lethal dose can be described in terms of molecules rather than in milligrams or grams speaks volumes about its lethality! So less is the fatal dose of BTX-A that it is often measured in a special unit called a mouse unit. It is a very small quantity. One Mouse Unit of BTX-A is equal to just 3 x 107 molecules. Again because of its such high lethality, many nations have seriously thought about using it as a biological weapon. As a biowarfare or terrorist agent, exposure is likely to occur following inhalation of aerosolized toxin or ingestion of food contaminated with the preformed toxin or microbial spores. Recently, Iraq admitted to active research on the offensive use of botulinum toxins and that they weaponized and deployed over 100 munitions with botulinum toxin in 1995.” “Oh, that is really interesting. Doctor, does this bacterium forms spores too?” “Oh, yes. The bacteria does form spores, when it finds that the conditions have become difficult for it to live. These spores (in contrast to toxin) are highly heat resistant, requiring exposure to moist heat at 1200C for 30 minutes for inactivation, as in steam sterilizers or pressure cookers. The spores are ubiquitous. They are present in soil, sea water and even air. Earlier I was telling about the fatal dose of BTX-A. I must tell you that its fatal period is just about 24 hours. I may also tell you that the toxins formed by Clostridium botulinum are known as exotoxins. Very broadly speaking exotoxins are those toxins which are produced by bacteria while they are still alive. On the contrary, there are certain other bacteria which release toxins when they get killed. Their cell walls rupture and the toxins are released. Those toxins are known as endotoxins. Thus the correct term for Botulinum toxin type A is BTX-A exotoxin.” “That is a lot of information doctor. You told that these bacteria make toxins while remaining in the can. Then the food inside must get spoiled too. Then why at all does someone consume such food?” “Unfortunately that is not the case. The food may or may not appear spoiled, depending on what strain of bacteria attacked it. If it released proteolytic enzymes, (the enzymes which break down proteins) along with the toxin, the food would spoil, otherwise not. Food contaminated by type A and B bacteria often appear putrefied, because they release proteolytic enzymes too. In contrast food infected with type E bacteria may look and taste normal, as they do not produce proteolytic enzymes. There are however ways to prevent botulism. First of all, if you are buying cans of food from a supermarket, never buy cans which are leaking, spouting, dented or otherwise show any other sign of abnormality. This is because the bacteria may release gases during their activity. And this build up of gas pressure inside the can may cause all these effects. Secondly all canned items should be cooked thoroughly by boiling and stirring for 15 minutes. This destroys any toxin if it is present. Commercial canners usually heat food to at least 1200C to guarantee the destruction of both toxins and spores. If you don’t want to use the food cans immediately, the cans should be frozen or refrigerated at very low temperatures. This is because some strains, especially type E, can produce toxin at temperatures as low as 50C. So a temperature lower than this must be achieved. There are some precautions suggested for those who do canning of food at home. One is the use of phosphoric and citric acids during canning. This is because the optimum pH for the growth of these bacteria is between 4.6 to 7.0. pH above and below this range are not conducive to their growth. Acid environment obviously is not conducive to their growth, and the use of phosphoric and citric acids provide a sound acidic environment. This is also the reason why acidic fruits may generally be safely canned. Many other facts seem to prove that an acidic environment prevents the growth of C. botulinum. Infants below the age of one year seem to become victims of infant botulism for the reason that their gastro-intestinal tract (GIT) is deficient in bile acids and gastric acid, which normally prevent the growth of C. botulinum. For preventing botulism, it has also been suggested that if you are canning meat at home, it should be cured with sodium nitrite (3.5% to 6%). This is said to prevent botulism, as sodium nitrite has an antimicrobial, especially antibotulinal activity. There is however a controversy that when such cured meats are fried, the nitrites may get converted to nitrosamines, a known carcinogen. But this is a different controversy and we would not concentrate it here now.” “Doctor, how does Botulinum A Exotoxin work? “BTX-A is an enzyme. It produces its effects by preventing release of acetylcholine (ACh) from the nerve endings. This chemical is very necessary for the transmission of impulses across nerves. Thus in a way the connections between nerves become ‘dead’, and the activities of the whole organism come to a stand still. Do you remember how Badal had a paralysis of his arms and legs? This is typical of botulism. Actually it was this symptom, which partly alerted me and made me think in this direction. I may tell you that the symptoms of food borne botulism start within about 18-36 hours of ingestion of contaminated food. After having food with Shatru, Badal also developed his symptoms roughly in the same time period. This period has often been referred to as the incubation period, but it is a actually a misnomer. The illness may be very mild for which no medical advice may be sought, or it may be so fulminant as to cause death within 24 hours. Badal died within three and a half days.” “Doctor, you have just mentioned a term “food borne botulism”. Does this mean there are other forms of botulism too?” “Oh yes. In fact the Center for Disease Control in Atlanta, USA (often referred to as CDC) currently classifies four different types of botulism. The first is the food borne botulism, which occurs from ingestion of preformed toxins. This is the best known form, and I have been talking about this form till now. The second form is infant botulism, which occurs mostly in infants below 6 months of age (90% cases). Rest of the cases occur between the ages of 6 months to 1 year. It occurs not from the ingestion of preformed toxins, but from ingestion of spores, which germinate in the mildly alkaline environment of the intestines, and produce toxin in-vivo, which gets absorbed. In adults the bile acids and the gastric acid tend to restrict the growth of C. botulinum. But the gastrointestinal tract of infants lacks these acids, and this factor may be responsible for their growth. Since the toxin is formed within the intestine and is absorbed gradually, the symptoms and signs are less dramatic, compared to adult type food-borne botulism, where preformed toxin is ingested all at once. The first signs to toxicity in infant botulism are constipation, feeding difficulty, feeble crying, and a “floppy” baby with diffuse decreased muscle tone, particularly apparent in the limbs and neck. Infant botulism is the most common form of botulism. Certain infants are more susceptible to infant botulism, while others seem resistant. The reason for this strange phenomenon is not clear. It is believed that giving of honey to infants may be a source of infection, as it contains spores of C. botulinum. Giving of honey to young infants is thus not advised now. The third form is Wound botulism, which occurs due to contamination of wounds with spores of C. botulinum. This usually occurs when they get soiled with dirt and nothing is done about it. The condition is also seen in chronic drug abusers and after caesarian delivery. This entity was first noted in California in 1976. This has now become the most common form of botulism. The symptoms and signs are quite similar to those seen in food borne botulism, except for the fact that gastric symptoms like nausea and vomiting are absent in wound botulism. Finally there is the Indeterminate type, which occurs in patients over 1 year of age with no recognized source for disease. Some authorities suggest that a mechanism similar to infant botulism may be at work here. Their studies suggest that the adults may ingest spores of C. botulinum, which may germinate in the gut, much like they do in infants. Several factors such as achlorhydria in these people, i.e. lack of acid in the stomach may be responsible for their germination. You may recall that I told you strongly acidic environments restrict the growth of this bacteria.” “Yes, I do. Doctor, in the beginning you told that this toxin is also used as a medicine. How can this toxin - which you say is the most dangerous toxin in the world - be used as a medicine? To me this sounds like a paradox.” “Tarun, now it is known that wrinkles in old people are caused by sustained contraction of facial muscles. If somehow these muscles could be paralysed, these wrinkles would go away too. BTX-A does this remarkably well. This toxin in nanogram doses is used for removal of wrinkles. Injection of BTX-A directly in these muscles causes their paralysis, which are then allowed to weaken by atrophy over a 3-week period. Similarly the toxin has been used in the treatment of certain eye disorders such as blepharospasm (abnormal contraction of eye lids) and in squint surgery. Commercially BTX-A is available under two different trade names - BOTOX and Dysport (produced by Speywood, Maidenhead, United Kingdom). BOTOX is prepared by a multiple precipitation technique, whereas Dysport is produced by column-based methods. These are technical terms and you need not bother about them. Suffice it to say, that this difference in production methods produces a differential between the effects on humans and mice. In particular, the dose (in mouse units) of Dysport required to produce a given effect is 3 to 4 times greater than the dose of BOTOX. Now I will come to the most important point. Work in primates, in conjunction with estimates derived from accidental botulism, suggests a human fatal dose of approximately 40 U/Kg if the toxin is delivered systemically. The BOTOX vial contains 100 units; the Dysport vial, 500 units. Thus a few vials if mixed in someone’s whiskey would be enough to kill him. This is actually what Shatru had done. I suspected him the moment I came to know that he was a brilliant student of microbiology and also when I heard the typical symptoms of Badal. I have chemically examined the blood of Badal and it shows BTX-A. I did not stop at that. I also did bioassays which proved that the blood of Badal contained something which paralyses muscles.” “What is a bioassay doctor? “Bioassay is a term which refers to determining a chemical by biological means. I prepared an extract from Badal’s serum, and injected it in mice. By doing this, I could produce paralysis in mice, which was a positive indication that some abnormal substance was there in Badal’s blood. I have lab reports to show to the court that this abnormal substance was in fact BTX-A. Now I will tell you one more secret. I sent policemen to Shatru’s house and they have recovered some empty BOTOX vials from his house. These vials had no business being present in his house, which tells us that he is the one who mixed those vials surreptitiously in Badal’s whiskey. Come let us tell the police to put him under more sustained questioning, and he would surely spill the beans.” “That is very clever of you doctor. Without your clever deduction it would have been impossible to say how Badal died and Shatru may have gone scot-free. What are you going to tell me next time?” “Tarun, next time, I would tell you about a very interesting poison - Lithium.”

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Reviewers' Board: Best Toxicology Books A journal affiliated to Anil Aggrawal's Forensic Toxicology Page V.V.Pillay, MD, DCL Professor, Dept. of Forensic Medicine & Toxicology Chief, Poison Control & DNA Typing Units, Amrita Institute of Medical Sciences & Research, Cochin 682026 South India E-mail: toxicology@medical.amrita.edu Professor V.V.Pillay has been in the vanguard of the movement among medical professionals in India to develop the neglected field of Toxicology. He has published extensively in both the scientific and lay press on matters relating to Toxicology, as well as his chosen discipline - Forensic Medicine. Dr.Pillay has authored 5 books on Forensic Medicine and Toxicology, and has received an award for one of them (Modern Medical Toxicology), generally considered to be a trend setter among books on the subject in India. He has reviewed several books on Toxicology for the Internet Journal of Forensic Medicine and Toxicology. Dr.Pillay received a scroll of honour in appreciation of work done in the field of Toxicology from the Medicolegal Society, All India Institute of Medical Sciences, New Delhi. He is instrumental in establishing a state-of-the-art Poison Control Center at the institute where he is currently employed, which is among the few such Centers in India recognized by the World Health Organization. Among his most sought-after publications is a 700 page reference work on Toxicology. Dr. Pillay has recently started a professional organization exclusively dedicated to toxicology - The Indian Society of Toxicology, which has drawn membership of professionals and researchers from all over the country and abroad. The Society brings out a peer reviewed journal biannually (Journal of Indian Society of Toxicology). Professor Pillay is also an Executive Editor in Anil Aggrawal's Internet Journal of Book Reviews.

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE DECEMBER 1997 ISSUE THE POISON SLEUTHS DEATH BY LYSOL -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today. You seem to be doing the post-mortem on a very old man. He is showing some ghastly trickle marks over his chest and abdomen too. What happened to him? Please tell me." "Good morning Tarun. The name of this man is Ramlal and he is 60 years old. His dead body was found in his house on 29 November at 8 am. He lived alone in his house. His wife had expired some time back, and his two sons had both left him, and were living abroad along with their families. The most peculiar thing about the dead body, as you have already commented upon, are these strange and curious reddish black trickle marks starting from his mouth and going on to his neck and chest..." "Yes certainly. I would think he had been poisoned by someone?" "That's exactly what the police is thinking. It certainly appears that someone had given him some poisonous substance to drink. No poisonous substance has however been found in the vicinity of the body, and this substantiates the belief that Ramlal was indeed poisoned..." "What significance does the presence of poisonous substance near the body has?" "If the poisonous substance is found near the dead body, the presumption is that the person took it himself. The reason is that he might have died soon after taking poison, and had no way to remove the poison from the vicinity. On the other hand if the poison was administered by some poisoner, he would take the remaining poison with him. However there have been cases where the person has taken the poison with suicidal intention and then kept the poison back at some secret place, before the death actually occurred." "Oh, I see." "Well, the fact that no poison was found in the vicinity of Ramlal gave rise to the suspicion that someone visited Ramlal, perhaps on the previous day and gave him something to drink. After Ramlal had drunk the potion, the poisoner left. The suspicion of Police has fallen upon Pyare, who had an old axe to grind with Ramlal. Ramlal had lent Pyare Rs 20,000 about 2 years back which Pyare was not returning. Recently Ramlal had intensified his efforts to get the money back. Pyare was unable to give the money back. Recently Ramlal had threatened to go to the police if Pyare did not pay up within two weeks." "Sure enough, Pyare had lot of good reason to do away with Ramlal?" "Yes, and he has a criminal background too. Twice before he had been to jail, once for shoplifting, and once for eve-teasing. He had even visited Ramlal on the evening of November 28, just one day before the body of Ramlal was found. Several neighbors had seen him entering Ramlal's house. There were angry shouts from within the house after which Pyare hurriedly left. As you can plainly see, all this evidence is against Pyare, but when the police questioned Pyare, he expressed his complete ignorance about the death. The police inspector Gajendra Singh had decided to apply third degree methods to Pyare, when this case was brought to me." "So how you are going to find out if Pyare had indeed done away with Ramlal?" "Well, look at the body first (Please reproduce handmade fig 1 here). These trickle marks have surely been made by some strongly corrosive substance. Such a strong corrosive substance could only have been administered by Ramlal himself. No one could possibly give this substance to him. So it appears that Pyare indeed is innocent." "How can you prove it scientifically?" "Well. I have examined the stomach contents chemically and have found them to contain large quantities of Lysol..." "Never heard of such a substance. Doctor, please give me some more information about lysol." "Really! Well, let me first tell you about a related substance Carbolic Acid. Both carbolic acid and Lysol are very strong poisons. They are chemically quite closely related too. The chemical formula of carbolic acid is C6H5OH. It is known by several other names, some of them being Phenol, Phenyl alcohol, Phenic acid, and Hydroxybenzene. It is a colorless substance, but its needle-like crystals turn pink and liquefy when exposed to air. Although we call it an acid, it is not a true acid and does not redden litmus paper. It has a sweet burning taste and a distinct `carbolic' smell, the one which you would usually get in hospitals or operation rooms. In homes too we generally use it in our toilets. It is usually known as Phenyle in ordinary parlance. It looks like a thick syrupy brownish red liquid. "Oh sure we do use it. So it is carbolic acid?" "Yes it is. It is soluble in water. Its solubility in water is 6.7 g/100 ml at 160C. Besides water, it is soluble in many other solvents including alcohol, ether and glycerine. The commercial carbolic acid is a dark brown liquid containing several impurities, chiefly cresol." "Well, we are getting another new substance. What exactly is cresol doctor?" "Tarun, cresol is a mixture of three isomers of methyl phenol (CH3C6H4OH). It is now known to be a better disinfectant than phenol. It is less toxic than phenol, yet has a better germ killing activity. It is available in the market as an oily solution known as Lysol. Sometimes even lysol is used as a disinfectant in homes. This is what Ramlal has ingested." "Doctor, you talk about germ killing activity of phenol. Now I am beginning to recall. Isn't carbolic acid the same which was proposed by Lord Lister as an antiseptic?" "You are right Tarun. In fact Carbolic acid was originally introduced by Lemaire as a disinfectant and its use for this purpose became general when Lord Lister chose it as an agent to prevent and cure sepsis. Lord Lister was a British surgeon who was born in England in 1827. In his time, the concept of antiseptic surgery was completely unknown and many patients died after the operation because of infection. For the first time, Lister came to the right conclusion that the infection was caused by the bacteria present in the air. To kill those bacteria, he used carbolic acid. The first operation in which he used carbolic acid was performed in March 1865. Surely, no infection occurred. Subsequently all operations were conducted in rooms where the air had been disinfected with a carbolic spray. Lord Lister also introduced carbolized oil for the storage of catgut sutures. The Listerian method soon yielded great benefit to the patients but unfortunately, the poisonous nature of the remedy took its toll too. Many patients died when the wounds were disinfected with carbolic acid, because it was absorbed in the system." "Oh, it appears every good thing has its own bad aspects too." "Things were not as bad as they appeared. Safer disinfectants were soon discovered. The principal modern phenolic disinfectants include Lysol which is a 50% solution of cresol in saponified vegetable oil. Lysol is only about one-eighth as poisonous as phenol. And it might come as a surprise to you that the modern Dettol is also a relative of carbolic acid. Of course it is even less dangerous than lysol, so much so, that it is frequently used by people for disinfecting wounds even without the recommendation of a doctor." "Then why do people use Lysol at all?" "Lysol is mainly used for disinfecting bathrooms and toilets. The term Lysol is a actually a trademark rather than a chemical term. The chemical term as I have already told you is cresol. It might interest you to know that this trademark was first registered by a German firm, but following the First World War, this registration was cancelled. It is however still a protected trademark in certain countries, notably in the United States, and thus the term is always written with a capital L. Lysol has an amber or red-brown color and a distinctive phenolic odour. Although it is only about 1/8th as toxic as carbolic acid, it remains quite irritating, and its toxicity is well known. You can see that Ramlal died because of this poison. It is alkaline in nature, and it is its alkalinity that makes it more irritant. During the 1930s, it was a common choice of the suicides by poisoning. It can be absorbed from the intact skin and concentrated solutions of it are corrosive." "Doctor, can lysol be used as a homicidal poison?" "Hardly. The reason is that it is so corrosive and has such a distinctive color and smell. As I told you in several of my earlier meetings, an ideal homicidal poison should be colorless, odorless and tasteless. However it has been used as an irrigating fluid for inducing abortions by quacks..." "What does that mean doctor?" "Tarun, if an unmarried girl becomes pregnant, she wants to have an abortion for fear of society's ridicule. And for this purpose she frequently contacts quacks. They do not know of the modern safe methods of abortion and use age old dangerous methods. One of the methods is to irrigate the uterus with strong irritant substances, such as phenol or lysol. The solution is passed through the vagina through a tube. Whether it really expelled the uterine contents is anyone's guess but what is certain is that it caused several deaths of pregnant girls." "Really? So even a passage in the uterus can cause death. But how?" "Tarun, it can enter the blood stream through dilated uterine veins and can cause fatal poisoning. You must remember that in pregnant women, the uterine veins are often very much dilated. Since all veins empty in the right side of the heart, it is reasonable to expect the right side of the heart to contain unusually high amounts of lysol in such deaths. If high amounts of lysol or phenol are found in the right side of the heart, it is safe to assume that some quack did administer phenol or lysol to the unfortunate mother through the vagina." "Very clever doctor! Tell me, are there some other points which can help you prove that Ramlal did die of lysol poisoning?" "Tarun, the greatest proof is the chemical report of the stomach contents. But there are other findings too. Look at the stomach wall. It is soapy to touch. You would remember that lysol is actually a solution of cresol in saponified vegetable oil. It is because of this fact that the stomach wall is appearing soapy to touch. Further, you can find that the stomach wall is reddish brown. This is the color of lysol. The stomach wall is also soft in texture, and this is how the stomach wall becomes in lysol poisoning. Of course the trickle marks over the face, chest and abdomen also go in favor of lysol poisoning. Ramlal has indeed taken the poison himself. This poison couldn't have been administered to him by Pyare, who in fact is innocent. Ramlal was actually extremely depressed because his wife had died and his sons had left him. After Pyare left him on November 28, Ramlal became all the more depressed, because of constant irritations from various quarters. Sure enough in a bout of severe depression after Pyare left, Ramlal ingested the poison, and finished himself. Come let us tell the police about our findings." "Wait a minute doctor. Where is the bottle of lysol? If Ramlal took the poison himself, he couldn't have removed the bottle. Then why haven't we found the bottle?" "Tarun, death in lysol poisoning occurs in about 3-4 hours. So Ramlal took the poison, and put it back in his almirah. I have looked in his almirahs and have found the bottle there. It is half empty. It shows the fingerprints of only Ramlal. No fingerprints of Pyare have been found on it. So it seems that Pyare indeed is innocent." "Oh, how very clever of you doctor. This was a most interesting discussion. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about a very deadly poison- Phosgene "

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE APRIL 1999 ISSUE THE POISON SLEUTHS DEATH BY ARSINE GAS -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a middle aged man today. What has happened to him? Please tell me." "Good morning Tarun. The name of this middle aged man is Radhey. He used to work in a factory, where they used to make soldering flux. He was working in his factory five days ago, when at about 2 pm, suddenly he started having nausea, headache, vomiting and diarrhea. He had taken lunch only a few minutes before so naturally everybody started thinking that he had had food poisoning. His illness soon became worse. He started complaining of intense headache and pain in the loins. He passed urine after sometime, and everybody was alarmed to see that it was very dark. He was taken to the hospital, where the doctors were unable to diagnose his illness. However the history of having taken his meals only a few minutes before, and the non-specific symptoms prompted some doctor to write "undiagnosed poisoning" on the hospital case sheet." "So it was a case of poisoning? Was somebody else was poisoned too?" "No, nobody else was poisoned - of course presuming that Radhey died of poisoning. Only Radhey showed these peculiar symptoms. The tentative diagnosis of "undiagnosed poisoning" flared up everybody's tempers, especially those of Radhey's relatives. They thought that somebody had surreptitiously mixed poison in his food. And all suspicion fell on another man Suleiman." "Why on Suleiman doctor?" "Because and Radhey apparently did not have good relations. They did not even talk to each other. Nobody knows how their fight started, but it is for sure, that they were sworn enemies. After Radhey was taken to the hospital, the doctors tried their level best to save him, but they could not, and he died today morning after an illness of about four and half days. The doctors refused to give a death certificate, as they did not know the illness Radhey was suffering from. Meanwhile the relatives of Radhey actually lodged an FIR in the police station, in which they alleged that Suleiman had poisoned Radhey, and he should immediately be taken in custody. Apparently the relatives of Radhey had some political clout too, so the police had to act fast. Now they have sent this body to me. My job obviously is to find out how Radhey actually died." "Very interesting indeed. That explains the big mob outside your mortuary. When I came to meet you, I was surprised to see several people sorrounding this mortuary several of whom were toting cellulars." "Yeah, they are very influential people, and apparently they would leave the mortuary only after they have come to know of the cause of Radhey's death. The pressure on police was so much that they had to arrest Suleiman." "What does Suleiman say doctor?" "I have talked to Suleiman myself. The police has also talked to him. He says he has absolutley no hand in this killing. He has hired a lawyer for his defense and he is pressurizing the police by saying that they can not arrest his client without any solid evidence. So the police are finding themselves in a Catch-22 situation. As you can understand, I have been showered upon with a very heavy responsibility." "Yes indeed. I can understand that. Now where do you start from?" "Tarun, I have already started actually. Whenever a death occurs in a factory, I make it a point to visit the factory first and see what kind of activities were going there. I found that Radhey was involved in making soldering flux by putting zinc scrap in hydrochloric acid." "Please explain this to me in some great detail doctor." "Tarun, in several industries there is a "rough and ready" practice of producing zinc chloride to provide a soldering flux by putting zinc scrap in hydrochloric acid. This is actually not recommended as sometimes a very poisonous gas arsine may form in this process. The zinc scrap may contain arsenic as an impurity, and when arsenic acts with hydrochloric acid, it forms arsine (AsH3) a very dangerous gas." "So you think Radhey died of arsine gas?" "I can't say for sure at present, but after you know more about this interesting gas, you can make a guess yourself." "Looks like we are on the trail of yet another interesting poison. Doctor please tell me more about arsine gas." "Tarun, arsine is a very toxic gas, a molecule of which contains just four atoms - three of hydrogen and one of arsenic. It is a colorless inflammable gas. It is supposed to have an odour of garlic, but it is not always apparent, especially when a person is suffering from common cold. It is an unstable compound which when exposed to light or moisture, decomposes to deposit arsenic. It is heavier than air, its vapour density being 2.68 times that of air. You might be surprised to know that the German chemist Gehlen died of accidental arsine poisoning in 1815." "Oh, I didn't know that." "Tarun, arsine is one of the most poisonous gases known. It can kill outright. Even brief exposure to moderate concentrations can cause serious illness. I will give you some figures which will tell you something about the killing power of this gas. The four most poisonous gases are carbon monoxide, phosgene, chlorine and arsine. Inhalation of carbon monoxide in concentrations of 1000 parts per million (ppm) for a few minutes can cause death. The equivalent figures for Chlorine and Phosgene are 400 ppm and 50 ppm respectively, meaning thereby that they are more poisonous. Obviously the lesser concentration required for killing, more poisonous the gas. You would be surprised to know that in the case of arsine, only a concentration of 10 ppm inhaled for about half an hour could be dangerous. And at such low concentrations, the pecualiar garlic odor of the gas may not be apparent at all. The safe maximum concentration of carbon monoxide - generally considered by all to be very toxic - is 100 ppm, while that of arsine is just 0.05 ppm. This can give you some idea of the lethality of this gas" "Oh, sure. From the figures it appears to be about 2000 times more poisonous, which is remarkable. Especially considering the fact that everybody considers carbon monoxide to be a very deadly gas." "Exactly. Like carbon monoxide, arsine is a cumulative poison too. This means that it is excreted much more slowly from the body than it is absorbed. This results in gradual accumulation of the poison in the body which can be very dangerous. A good simily is of a tank, in which poisonous water is entering much faster than it is being let out. This would ultimately result in overloading of the tank with the poisonous water." "Yes, I understand. But what is the significance of a cumulative poison doctor?" "Tarun, it means that repeated or prolonged exposure to even a very low concentration can be dangerous. Thus a cumulative poison - that whose excretion rate is slower than that of its absorption- is a much more dangerous poison, than a non-cumulative poison. The hazard of arsine gas exists in a number of industries including the refining of metal, the manufacture of corrosive acids, galvanizing and electroplating. It is also a risk in laboratories. There was a time when the use of wall papers colored with pigment which contained Scheele's Green, yielded arsine in the home, when acted upon by a mould. This could create severe poisoning in the inmates, especially considering that arsine is a cumulative poison." "Just a minute doctor. What is Scheele's Green?" "Tarun, Scheele's Green is a popular name for cupric arsenite. Its formula is Cu3(AsO3)2.2H2O. It is named thus in the memory of the famous Swedish Chemist Kark Wilhelm Scheele (1742-1786). It is a brilliant green pigment which was once used for paints, but since it is a potentially poisonous compound, it is no more used now. When mould acts on this compound, arsenic may get combined with hydrogen molecules and may form arsine, which may be very poisonous. Arsine may be produced in quite a few other remarkable ways." "What are those doctor? Please tell me." "Tarun, I know of a unique case of industrial poisoning by arsine in which three men were poisoned - one of them fatally. They were engaged in unloading fish scrap from the hold of a wooden schooner. The close, warm atmosphere promoted bacterial activity and, in turn, the production of arsine." "Oh that is indeed quite unusual." "Yes. Another likely source of arsine is the interior of tanks used in the preparation of sulphuric acid from iron pyrites (sulphide). Some of the deposits in these tanks was hard and had to be scraped from the walls. It contained upto 45% of arsenious oxide. The production of arsine from this material was unsuspected for quite some time. In yet another case, a person had cleaned a water jacket by pouring freshly diluted hydrochloric acid into its pipes. Fumes were liberated and he was in close contact with them in an unventilated room for about half an hour. The acid contained an "inhibitor", which proved to be a mixture of sodium arsenate and aniline hydrochloride. Arsine was produced from the inhibitor n the presence of nascent hydrogen and the man was severely poisoned." "Oh, I see. Arsine can be produced in most unusual circumstances. It does appear to me that Radhey too got involved in arsine poisoing." "Yes, it became apparent to me, when I came to know that he was involved in making the soldering flux by that precarious method, which I have described you just now. My suspicion was confirmed to a great extent when I heard that he had passed dark urine. This was because of the presence of hemoglobin in the urine." "Why should hemoglobin appear in the urine in a case of arsine poisoning?" "Arsine is a deadly poison tarun. It hemolyses (breaks) all the Red Blood Cells of the body. This liberates hemoglobin which ultimately finds its way in the urine which become dark. I have made some slides of the blood of this patient, and you can see under the microscope that all the R.B.C.s are broken. This is a very strong indication that he had died of arsine poisoning. Moreover his kidney tubules are blocked by these broken R.B.C.s which is another finding in favour of arsine poisoing. Coupled with his peculiar history, I am sure Radhey died of arsine poisoning, which is an accidental poisoning. Suleiman had nothing to do with it. Come, let us tell the police about it." "Very clever indeed. This was a most interesting discussion doctor. Without your masterly deduction, police could have unnecessarily went on harassing Suleiman. Radhey's relatives and other people might have thought, it was a case of killing by Suleiman. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about death by aflatoxins. "

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE OCTOBER 1998 ISSUE THE POISON SLEUTHS DEATH BY ALUMINIUM PHOSPHIDE -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a young lady today. What happened to her? Please tell me." "Good morning Tarun. The name of this young lady is Sushila, and she was found dead in her bed today morning. It is suspected that her husband gave her something in her food, which took her life. I will tell you some details, which will put the whole crime in perspective for you. She was married to a young boy Suresh only 2 months back. Suresh is a petty clerk in a bank, and it appears that there was a dowry demand in the house, which was not properly catered to, by the bride's side. Because of this there was a lot of tension in the house, and Sushila had complained several times to her parents about it. Now suddenly she is found dead in her bed. It is suspected by Sushila's parents, as well as by the police that Sushila has been given some poison by Suresh and his parents to do away with her." "What makes them think that? Do they have any proof against them?" "Well, the main thing is that there is a very strong motive for Suresh's parents to kill Sushila- dowry. They could get their son married again for better dowry. It seems a reasonable motive. Moreover brides don’t usually die so mysteriously just after 2 months of their marriage, until and unless there is some serious trouble with the marriage." "But it is quite possible that she committed suicide. What makes the police think that it is a case of murder?" "Well it could be. But Suresh and his parents are going one step further. They are alleging that she may have died of some natural disease. In fact Suresh has alleged that she had some gynecological problem about which she once discussed with him." "Really? Did you find any evidence of a fatal disease in her body? And by the way, have you found something in her stomach?" "Tarun, I didn’t find any fatal disease in her body. If she had any of it, like leukemia, or other cancers, or some gynecological trouble, I would surely have found out. I have indeed analyzed the contents of Sushila's stomach and I have found out lot of Aluminum hydroxide in her stomach." "Aluminum hydroxide? Doesn't seem like a poison to me. It is a very weak alkali though. Can it kill someone?" "You are right. Aluminum hydroxide generally doesn't kill a person. But just by it's presence, I have come to know of the poison, which might have been administered to her." "And what that poison is doctor? Please tell me. I am getting curious." "Tarun, it is Aluminium Phosphide, a very dangerous poison. It is available in the market at tablets of Celphos, Quickphos or Fumigant. The last trade name is perhaps quite apt. These tablets are used for killing insects in the grains such as wheat and rice. Generally people buy these tablets and mix them with stored wheat. Insects which would otherwise appear in these grains after some time, generally don’t appear if you preserve the grains along with these tablets." "Oh, I see. I have heard about such tablets. But how do they prevent insects from breeding inside the grains." "Tarun, when Aluminium Phosphide comes in contact with water, or moisture in the air, it liberates a very dangerous gas phosphine. This gas is actually dangerous for the insects, and they can't breed inside the grains. Since you are so good in chemistry, I will give you the exact chemical equation of this chemical reaction. The chemical equation for the liberation of phosphine is: 2 AlP + 6 H2O = 2 Al(OH)3 + 2 PH3 I hope it is quite clear to you. The gas phosphine is liberated and aluminum hydroxide is left behind." "Yeah it indeed is clear to me. Tell me why such a dangerous poison is freely available in the market. I agree that it is such a good fumigant, but keeping in mind its poisonous nature, can't the scientists find some better alternative?" "That's a good point of discussion Tarun. In fact there has been much debate and discussion on this already. But I don’t want to go into that. For the time being I will tell you why they are finding it so hard to abandon it. Aluminum phosphide is commonly used as insecticide, rodenticide and fumigant all over India and even in developed countries. To be sure, there are several other fumigants available, such as ethylene dichloride, ethylene dibromide, carbon tetrachloride mixture and methyl bromide. But only aluminum phosphide is considered as an ideal fumigant over all other fumigants. It has almost all the properties of an ideal fumigant…." "Really? What are those? Please let me know." "Tarun, Aluminum Phosphide is highly toxic to almost all stages of insects with remarkable penetration power. It dissolves well in water, oils and fats. It is considered an ideal seed fumigant since the seeds' viability is not affected and is practically free from residual toxic hazards- provided the seeds contain less than 20% water. It is minimally absorbed and easily desorbed from the treated commodity such as wheat grains. It is non flammable at the prescribed dosage and devoid of tainting on fumigated stock. It has a distinct odor, which has been described as a fishy odor. Because of this and also because of delays in evolving phosphine provide considerable safety in handling this fumigant. Since the tablet generates the predetermined weight of gas, it is very convenient to administer the exact dose. Cost of fumigation is low and its effects on the fumigated stock last longer. It is easy to transport and handle. Treatment is more or less known, so in case accidental poisoning occurs in humans, they can be taken care of. But unfortunately no specific antidote is known. These are all very desirable properties in any fumigant, and all of these are available in aluminum phosphide." "Doctor how can you detect phosphine in the environment?" "Tarun, Phosphine is a colorless and odorless gas, but when it is generated from aluminum phosphide tablets available in the market, generally there are some impurities along with it. Because of this, the gas has a typical garlic odor. Besides the smell, the presence of phosphine can be detected by a simple test. When a filter paper soaked with silver nitrate solution comes in contact with the gas, it turns from brown to black. The usual fatal concentration of phosphine is 200 ppm. After the reaction with moisture, less than 25% of the original tablet weight is left behind from which the amount of aluminum phosphide consumed can be detected." "Doctor, tell me something more about these tablets. I need to know more about them, so next time I see them, I recognize them at once." "Tarun, the tablets are dark brown or grayish in color, 3 g in weight and measure 20 mm in diameter and 5 mm in thickness. They come in an aluminum container containing ten tablets. Aluminum phosphide is also available as 0.6 g pellets. The tablets are composed of pure aluminum phosphide (the active ingredient) and ammonium carbamate/carbonate (the inert ingredient). The ratio of the active and inert ingredient is generally about 56:44. On contact with moisture each 3 g tablet evolves about 1 g of phosphine along with carbon dioxide and ammonia, which prevents self ignition of phosphine gas. This is why it is also called "Protective gas". Carbon dioxide and ammonia are liberated by combination of water with other inert ingredients in the tablets. In fact the main function of the inert ingredients is to produce these gases, so phosphine may not ignite easily. The phosphine gas thus liberated spreads quickly and kills insects and rodents almost in all stages of development. After complete decomposition of the tablet, aluminum hydroxide is left behind as a harmless and non toxic grayish white residue." "And this is what you have found out in Sushila's stomach. So it is almost clear that she died of Aluminum Phosphide poisoning. But how can you prove whether it is a homicidal or suicidal poisoning?" "Tarun, Celphos poisoning is generally suicidal in nature. As I told you earlier, the tablet emits a strange fishy smell. So it is rather difficult to administer it homicidally. It is almost certain, that Sushila took it with suicidal intention. I will give my report to the police accordingly. Of course the police can still register the case as murder under Section 304B of Indian Penal Code. This section defines Dowry death. And this stipulates that the husband and his relatives are responsible for her death if the bride dies from any cause within seven years of marriage, and it is shown that she was harassed for dowry before her death. Of course, to bring Sushila's death under this section, the police would have to work hard, and prove positively beyond doubt that she was harassed for dowry, so I guess, it makes their task that much difficult." "Oh yeah, I am sure, they will be able to do that. This was a most interesting discussion doctor. Tell me what are you going to tell me the next time?" "Tarun, next time, I would tell you about a very interesting poison- Argemone mexicana. " Additional notes by readers On April 5, 2001, Sergio Salazar from Nicaragua wrote: In Nicaragua the aluminum phosphide is named "pastilla del amor" -tablets of love- because the suicides ingest these products. I'm a chemist and my job is analytical toxicology in the Instituto de Medicina Legal in Nicaragua. But when there are suicide by phosphine I don't know of any analytical procedure for the detection of phosphine residues. Would you suggest me any methodology? kind regards Sergio Salazar sergio1953@yahoo.com

Forensic Toxicology THE FOLLOWING ARTICLE APPEARED IN THE MAY 2000 ISSUE THE POISON SLEUTHS DEATH BY HYDROGEN FLUORIDE -Dr. Anil Aggrawal "Good morning doctor. Oh, my God, what are you doing today? You have the dead body of a young man today. He is showing some burns on his body, especially on his fingers. What happened to him? Please tell me.” “Good morning Tarun. The name of this person is Shamlal, and he worked in a sweetshop in a Delhi based shop as a sweetmaker. He had migrated from Bihar sometime back, and was living alone in his house. For some days he was having some conflict with a person named Sunder, who worked as a lab attendant in a chemistry lab in a local school. On this Holi (Holi is a traditional festival enjoyed by the Hindus about the month of March every year. Typically this festival is celebrated by throwing water and colors over the friends), Sunder reportedly came to Shamlal, and asked him to forget all past differences. You would surely agree with me that for Hindus, Holi is a festival when everyone tends to forget past enmities. Shamlal also wanted to bury the hatchet, and invited him inside and offered him sweets. After applying some color on the face of Shamlal, Sunder threw some watery liquid over Shamlal, as a gesture to play Holi. Shamlal immediately felt pain all over his body, but instead of helping him, Sunder immediately left the house. On hearing Shamlal’s hue and cries, the neighbors took him to a nearby hospital and admitted him there. He died in the hospital a day later.” “Oh, I see. But why is his body brought to you?” “Tarun, when Shamlal was admitted in the hospital, he told the police all the incidents. He also said that he started feeling pain after Sunder threw some watery liquid over him, under the pretext of playing Holi. The police strongly suspect that Sunder threw some corrosive substance over him, and they want me to tell them what substance it was.” “Oh, I see. So what was it doctor?” “Tarun, I have conducted a thorough autopsy on the dead body, and have examined his burns in detail. You can see this typical burn on his finger. I feel that Shamlal has been killed deliberately by a very deadly poison - Hydrofluoric acid.” “Hydrofluoric acid! Never heard of this acid being used as a poison. And come to think of it, how can you be so sure?” “Tarun, I made some discreet enquiries from the doctors who treated him at the hospital. I specifically asked them, how Shamlal described his burns. The doctors told me that he described his burns in a very strange fashion, especially those on his fingers. He said that he felt as if his fingers had been struck with a hammer! This is a very typical description of a Hydrofluoric acid burn by a patient.” “That is very strange indeed. I think, I should know more about hydrofluoric acid, before I could be able to understand your talks more fully. Please tell me in some detail about Hydrofluoric acid.” “Tarun, Hydrofluoric acid is also known as hydrogen fluoride and its formula is often written as HF or H2F2. It is a colorless, fuming liquid, with molecular weight 20.01. It boils at 19.40 C. It is its great solubility in water that causes it to fume strongly in moist air. HF is found extensively in industry and at home. It was first synthesized by the French chemist Edmond Frémy (1814-1894). It is one of the most important fluorine compounds, and is prepared by heating calcium fluoride in sulfuric acid. The aqueous solution of this acid, generally used commercially, is obtained by passing the anhydrous hydrogen fluoride vapors into a leaden receiver containing distilled water, thus yielding the acid in dilute form. Hydrofluoric acid is extremely corrosive and must be preserved in platic, lead or steel containers. It can not be preserved in glass bottles, as it has the property of dissolving glass (reacts with silica to form gaseous silicon tetrafluoride). In fact this property is used in a common test for the presence of a fluoride. For the same reason, hydrofluoric acid is also used extensively in various forms of glass etching, such as the marking of divisions on thermometer tubes and the etching of designs on glassware, and in other forms of ceramic etching, such as pottery decoration. It is also used for frosting and polishing glass, and for removing sand from metal castings. It is also used as a catalyst for the production of certain hydrocarbons for high-octane gasoline. Some of its other common uses are rust removal, in manufacture of dyes, plastics, germicides, tanning, solvents, fire-proofing, pottery glazing and photography. It is also used as a laboratory reagent.” “Oh, that is interesting. What are its harmful effects on humans” “Tarun, scientists have studied its harmful effects in animals systematically by exposing them to varying concentrations of Hydrofluoric acid vapors. This helps to study the effects in man too. When inhaled by rabbits and guinea pigs in a concentration of 15 mg/cu. meter, they could tolerate it for prolonged periods. A concentration of 24 mg/cu. meter was tolerated for a total of 41 hours without fatality, although the animals subsequently lost weight. In a concentration of 50 mg/cu. meter HF induced signs of mild irritation, such as coughing and sneezing, which appeared to lessen after 5 to 15 minutes. Inhaled in greater concentrations, it acted as a severe irritant: the eyes were kept closed, paroxysms of coughing and sneezing were frequent, the respirations were slowed, and there was a copious discharge from the nose and eyes. Concentrations below 100 mg/cu. meter could be tolerated by animals for 5 hours without causing death. When exposed to the concentration of 500 mg/cu. meter for 15 minutes or more, all animals showed signs of weakness and ill-health. Inhalation at a concentration of 1000 mg/cu. meter for 30 minutes didn’t kill any animal, but caused damage to tissues. When inhaled at a concentration of 1500 mg/cu. meter for 5 minutes, all animals died, indicating this to be the fatal dose. When necropsies were done on animals, who had survived repeated exposures of HF, increased fluoride was seen in bones. Lungs, livers and kidneys were found damaged.” “Doctor, you said that HF is used in several industries. Does this mean, that industrial workers are also exposed to HF?” “Yes, surely. And they can get harmful effects too. The highest concentration of HF that can be tolerated by man for 1 minute is 100 mg/cu. meter. This causes a definite smarting of skin, a definite sour taste, and some degree of eye and respiratory irritation. If the air contains 50 mg/cu. meter, the sour taste is apparent and there is irritation of the eyes and nose, but no smarting of the skin. The concentration of 26 mg/cu. meter can be tolerated for several minutes, but the sour taste becomes evident after a short time, and there is mild smarting of the nose and eyes. You may want to know that the American Conference of Governmental Industrial Hygienists has adopted 2 mg/cu. meter as the threshold limit for hydrogen fluoride. This comes to about 3 ppm (parts per million).” “Doctor, I have seen some burns on the body of Shamlal too. Obviously they were caused by Hydrofluoric acid. Could you tell me in some more details about these burns?” “Tarun, contact of the skin with the anhydrous liquid produces severe burns. This is the most frequently reported route of HF toxicity. If the solution is not promptly removed, the skin may be penetrated by the fluoride ion, leading to the later development of painful ulcers, which heal slowly. Solutions of less than 20% HF can produce pain and redness up to 24 hours after exposure; 20 to 50% HF produces pain and redness within 8 hours, and solutions of more than 50% produce immediate burning, redness and blister formation. Fatalities have been reported from dermal exposure to as little as 2.5% of body surface area (about the size of the sole of the foot). HF burns range from first-degree to third-degree. The characteristic features are severe pain. Patients often describe feeling as if they had struck their fingers with a hammer! The hallmark of HF exposure is pain that is out of proportion to the burns produced. Only a few days back, I treated a case of Hydrofluoric acid burns in a young boy, on whom too, someone had thrown HF with an idea to kill him. He got severe burns on his legs. But fortunately I could save him. See this picture of his legs after one month. As you can see, he has almost recovered. His burn wounds are looking much more healthy. He became all right after a few months.” “Doctor, how much HF can kill a person?” “Tarun, inhalational exposure to concentrated HF for as little as 5 minutes is usually fatal, producing death within 2-10 hours. When HF is thrown on the body, the person may die in variable periods of time, usually within a day or so.” “How does hydrofluoric acid kill doctor.” “Tarun, you must be knowing that all acids yield free hydrogen ions or protons in solution. The more hydrogen ions an acid produces, the stronger it is considered to be. These hydrogen ions or protons exert a deleterious effects on the body in several complicated ways. That is why all mineral acids such as HCl, H2SO4 and HNO3 are so dangerous. HF is far less strong than its mineral acid cousins. It produces approximately 1000 times less free hydrogen ions or protons than an equimolar solution of hydrochloric acid, and about 450 times less free hydrogen ions than an equimolar solution of sulfuric acid. Yet it is this poor dissociation that proves so lethal to man. A poorly dissociated acid can penetrate far deeper in the tissues as it is uncharged. In fact all uncharged molecules have the ability to penetrate cells much better than charged ions. Combined with this ability is the specific ability of the fluoride ion to complex with body calcium and magnesium, even when present in exceedingly small concentrations. The combination of these two factors gives HF its unique toxicity. Free proton produced by HF does contribute to the injury (as in the case of mineral acids), but what is more important are the two factors I mentioned earlier, i.e. its unique ability to penetrate tissues, and its ability to combine with calcium and magnesium. This causes body calcium and magnesium levels to fall down. The body if affected in several other ways. I may also tell you about a unique property of the fluoride ion, which makes it very deadly. It can hold an electron more tightly than any other ion. This strong electronegativity of the fluoride ion allows it to bind tightly to any cation. These effects have the potential of disrupting all metabolic pathways, and may result in several body disorders.” “Doctor, now I know about HF enough to follow your talks. Tell me what has happened in Shamlal’s case?” “Tarun, I have no doubt in my mind that Shamlal has been killed by Sunder by this unique poison. Sunder worked in a chemistry lab, so HF was available to him. He offloaded some HF in a container and smuggled it home, with a view to throw it over his long adversary Shamlal. He knew that Holi was approaching soon, and he could throw it over him and leave the house quickly. As this is such a rare corrosive, he thought that he police would never be able to determine which corrosive was Shamlal killed with. But his typical findings and especially his typical description of his pain before death have given away everything. I have conducted some chemical tests on the washings which I took from Shamlal’s burnt areas, and they have tested positive for Hydrofluoric acid. Following this, I asked police to raid Sunder’s house. They did so, and found a half empty bottle containing HF. We then contacted the chemistry teacher of the school, where he was working, and asked him to check his HF supplies. He was surprised, as HF was hardly used in a routine way, and they always kept it under lock and key. But on our insistence he opened the lock and key and checked the HF bottle. To his utter surprise, it was empty. All these facts have confirmed, that Sunder stole HF from his school lab to throw it over Shamlal. Come, let us tell the police that Sunder is guilty and that the police must apprehend him.” “That is very clever of you doctor. Without your clever deduction it would have been impossible to say how Shamlal died and Sunder may have gone scot-free. What are you going to tell me next time?” “Tarun, next time, I would tell you about a very interesting poison - Fluorine."

| Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Partner with a Pioneering Forensic Science Publication Established in 2000, Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology is a biannual, peer-reviewed, open-access journal dedicated to advancing forensic medicine, toxicology, and related disciplines. With over 25 volumes published, the journal continues to serve as a reputable platform for professionals, educators, and researchers worldwide. The journal is indexed in several major abstracting services, including Chemical Abstracts Service, EMBASE, Index Copernicus, SCOPUS, and Web of Science (Clarivate). Sponsorship Opportunities: We invite organizations to collaborate with us and gain targeted visibility among a specialized audience. Sponsorship benefits include: Brand Exposure: Prominent placement of your organization's logo and promotional materials on our journal's website and publications. Global Reach: Access to a diverse readership comprising forensic professionals, toxicologists, legal experts, and academics from around the world. Thought Leadership: Opportunity to contribute articles or case studies, positioning your organization as a leader in the field. Align your brand with a respected publication at the forefront of forensic science and toxicology.

| Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology This Journal on CD Your favorite Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology is now available on a CD too, with lot more additional features. Among various other things, the additional features include important articles on forensic pathology, toxicology, forensic psychiatry and other material relevant to forensic pathologists in general. Useful pages like forensic quotations, aphorisms, importants maxims of forensic pathology etc. are also included in the CD. The journal has been made available free online in the interest of the forensic community in general. However the CD would still be useful to people who don't have access to an internet connection, or who have a slow internet connection. Through a CD, as we all know, all material can be accessed instantaneously and there is no waiting time at all. This is the main advantage of the CD, besides the fact that additional material is available in it. The CD would be most useful for libraries and private collections for archival purposes. The journal office distributes it at no-profit-no-loss basis. In case you need to know more about the CD, please email. Among our important patrons is the prestigious National Library of Medicine (NLM) at Bethesda, USA. Its NLM Unique ID is 100960452. To search the current holdings of this journal at the NLM site, please go to their site by email. Click on "Search Locator Plus", and search by Call Number (Select "Call Number Search"). The Call Number of this journal is W1 AN228DL. You may want to search by Journal Title ("Journal Title Search"). Simply write "Internet Journal" in the Search Box. You will get all Internet Journals acquired by NLM. There are about 30 of them, of which this journal is one. Anil Aggrawal's Forensic course is now available on audio cassettes too. For details, please email. For some additional information, you might also want to visit forensic careers page by clicking here.

Explore the intersection of coding and forensic science. Dr. Anil Aggrawal’s Forensic Programming page features tools, scripts, and insights that help automate forensic workflows and empower tech-savvy investigators. Tarun and Anil Aggrawal's Forensic Programming Page Hi, I am Anil Aggrawal, Professor of Forensic Medicine at the Maulana Azad Medical College, New Delhi, India. I am a lover of information and knowledge. "Knowledge is power", said Thomas Hobbes. It appears if he hadn't said it, I would have. Forensic Medicine is just one of the several subjects I love. Of course it occupies my main attention because it is my profession. I have always felt forensic professionals are very creative people. They have always wanted to do new things. Over the years they have been asking me over and over again, how they can make their own forensic pages. I made my first page, sometime in 1996, and have mostly been self-taught, through books, other web pages, discussions with friends and the like. But never in my life have I taken regular classes from a professional programmer. Lately a brilliant teacher has come in my life - my son Tarun. My Family You may want to skip this sub-heading. I wrote it mainly to please myself! But if you are curious about what these pictures are doing in a page on forensic programming, you may want to read on. I did not find these pictures abnormal at all, till Tarun asked me this question. I felt then, that this question needed to be addressed. A bit about my family first, without whose active support, these pages would not have been possible at all. The top row shows me and my wife Marygold just after marriage - sometime around 25 March 1983 (I got married on 16 March 1983). This picture was taken during our honeymoon in Mussourie and Dehradoon. The second picture was taken almost 19 years later - on 25 December 2001, when we visited our brother-in-law Sanjay Gupta in California. Among other things, it shows the inexorable stamp of time. The bottom row shows my son Tarun. He was born on 20 December 1984. The first picture was taken sometime in 1988, during our visit to Kausani, a lovely hill station in North India (it is now known mainly because the father of our nation, Mahatma Gandhi visited it once and praised this place). The second during 1996 during my visit to USA as a WHO fellow. He is trying threading his hand through the vertebra of a whale in a Washington D.C. Aquarium. Over the years he has grown into an intelligent and loving child. He is the one who is responsible for whatever I know about programming. But why the pictures? These show the two people I love most in my life (besides my mother, my two brothers and their families of course!). And it was mainly because of these two people that I could do whatever little I have been able to. If I could explore new vistas of knowledge, it was because my wife looked after me with great loving care. While she was looking after all my personal worries, I was busy learning new things. My child taught me programming like a great teacher. Hence their pictures. I would have known no programming at all without these two people in my life. Why these pages on Programming? Over the years forensic professionals from all over the world have asked me questions about the basics of computers and internet. They have asked how they could make their own web pages; how could they write their own programs to store and manipulate data (such as post-mortem data, clinical forensic medicine data and so on), and I have been answering them through Emails. Finally I decided I shall make a website which will say something about computers, internet and above all programming. No familiarity with programming is assumed from readers. They don't even have to know much about computers. The only thing they must have is a computer and the releveant program (say C++ compiler for C++, or Netscape or Internet Explorer for HTML). And they must know how to type! Programs can often be long, and it helps if you can type fast. No need to worry though if you don't know typing. Just copy and paste the programs in your compiler. Of course if you type out the program yourself, you learn faster. In this site, I hope to include simple lessons in HTML, DHTML, C++, Javascript, Perl, CGI, and whatever little I know of other programming languages. Are these pages relevant to Non-Forensic people too? Yes! Although these pages are meant specially for forensic professionals (I will be addressing their problems mainly), even non-forensic people can enjoy these pages. This is because the basic programming principles remain the same. I shall begin with C++, and then go on to other languages. You can go through lessons in order, test the various exercises in your computer and if there are any queries, you can always write Email to ask me. Books on Computers/Internet/Programming Although this site would initiate you into the world of computers, internet and programming, you can't learn everything there is to learn through these pages only. Very soon, you will begin to feel the need of proper books on these subjects. One of our main aims is to provide readers of these pages with information on latest books on computers, programming and internet in the form of book reviews. Readers may read the reviews of latest books and decide, which ones they would like to buy. A Lucrative Career in Forensic Programming Is there a career in Forensic Programming? Certainly. This specialty has skipped the attention of most professionals till now. But now more and more forensic and computer professionals are becoming aware of this specialty. To know more about careers in forensic programming and in other forensic fields, you may want to go to the forensic careers page. You may also want to go through the various books we keep suggesting on this site from time to time. It would help you get an insight into the world of computers, internet and programming, and you might be able to apply this knowledge to forensic fields effectively. From time to time, we also suggest other teaching aids such as multimedia, CDs, DVDs, Video and audio tapes. Look out for various announcements on these pages for these products. Enter Frequently asked questions What is Forensic Programming? Forensic Programming is the use of computer programming for the aid of police, judiciary and other law enforcement agencies. But how is this possible? That is indeed what we intend to discuss in these pages. It can not be explained in a sentence, but let me give you an illustrative example. Let us imagine that in a particular Forensic Medicine department, 1000 autopsies are conducted in a year. These would comprise a whole spectrum ranging from natural deaths to murders. If someone asked a pathologist of that department, how many, say, drowning cases had come to them in that particular year, he may not be able to tell you off hand, despite having been involved in ALL those cases. Finer statistics such as how many of them were homicidal in nature and so on, may be impossible to tell. But imagine what would happen if all this data had been cleverly programmed. At the touch of a button, one could tell not only the number of drowning deaths that year, but statistics such as homicidal, suicidal and accidental drownings, sex and age distribution, region of drowning, salt and fresh water drowning, time of the day when drowning occurred and so on. But how is it going to help law enforcement agencies? Suppose out of 1000 cases done by this hypothetical department, they dealt with, say, 91 cases of homicide. A good programming of this data would tell us, how many of these homicides were by gunshot, how many by sharp weapons and so on. This would also tell us the time of day/night when most homicides took place, the likely victims, the likely areas where homicides tend to occur and so on. Imagine how a police department can gear itself up, if it had all this data. They could, for instance, increase the patrolling in a particular area at a particular time, where most homicides occurred. Isn't it the same thing as Forensic computing or Computer Forensics? All of us are already aware of it. Forensic computing or Computer Forensics would involve using one's knowledge of computers - may be even programming - to track down criminals. A typical instance of this is a person who sent an Email to his cyberfriend asking her to meet at a particular place, and killed her after, say, sodomising her. An expert in forensic computing can examine the computer of the victim and from a thorough examination of the hard disk and data therein could perhaps track the man who was sending her Emails. Forensic programming is an entirely different thing. A forensic programmer DOES NOT track down a criminal at all. His sole purpose is to organize his data in a fashion so that it could be manipulated in a number of ways to give him useful information. Information, which could profitably be used by law enforcement agencies. Alright. Any more uses of forensic programming? We can think up a number of them. Let us talk about poisonings, or toxicological deaths. A good programming of our data can tell us how many poisoning cases are we dealing with, what are the most common poisons encountered, how many of them were homicidal, suicidal or accidental in nature. If, for example, we found that an alarmingly high number of deaths were occurring due to, say, accidental ingestion of corrosives, we might want to investigate why this is happening so. Or are these deaths indeed accidental in nature in the first place, or is there something more to it. Since when is forensic programming practiced? Who started it first? I am not sure. When I learnt programming, it occurred to me, we could use it in a clever way for our purposes. Which computer languages are most often used in forensic programming? Virtually any. But most often we would be using C++, Visual Basic, Java and so on. Does forensic programming make a good career option? Sure. It is the specialty of the future according to me. For more information, you may want to visit our forensic careers page.

< Back To Main Page. [Epub ahead] Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology Volume 27, Number 1, January - June 2026 Contents Papers Posttraumatic Ischemic Brain Stroke After Sharp Neck Injury: A Case Report Based on Autopsy By: Ivan Tsranchev ¹ , Pavel Timonov ² , Stela Yancheva ³ , Kristina Hadzhieva ⁴ , Teodora Gudelova ⁵ , Mirena Sotirova ⁶ , Antoaneta Fasova ⁷ , Elizabet Dzhambazova ⁸ , Petar Uchikov ⁹ Read Ivan Tsranchev